Stomach ache? It could be varicose veins in your tummy

Although Imogen Tyler rarely complained about her health, after her second child was born she suffered from a persistent stomach ache.

'I was so thrilled to have Bella, my daughter,' says the 37-year-old university lecturer from Lancaster.

'I just accepted my aches and pains as normal and believed things would get better.'

Persistent stomach ache? Imogen Taylor suffered an ache after having her second child - the doctor found she had developed varicose veins in her pelvis (picture posed by model)

But rather than improving, over the next 18 months the pain became progressively worse. 'It was like having a constant, throbbing toothache inside my body,' she explains.

'I'd feel fine in the morning, but as the day went on I would feel a deep, dragging pain around my pelvis.

'It wasn't crippling but it started to dominate my life - every time I walked into a room I'd look for a chair. I was taking painkillers every day.'

By the time Bella was two years old, the pain was so bad that Imogen was unable to stand even for very short periods.

'The pain became worse whenever I had been standing for any amount of time. I reached a point when I couldn't even stand for more than 15 or 20 minutes.

I had to lecture sitting down and by then I needed a ton of painkillers to get through every day.

'We love cycling as a family and for a long time I had to stay at home as the rest of my family went for trips to the Lake District,' says Imogen, who lives with her partner of 17 years, Bruce, also a lecturer, and their children, Bella, now five, and Louis, who is 13.

'By the time Bella was three, I thought: 'I can't live like this any longer.'

Mystery

When Imogen saw her GP, the doctor was unable to explain the pain. Imogen was referred to a physiotherapist, who advised her to do pelvic-floor strengthening exercises.

But the exercises didn't help, so Imogen decided to see a gynaecologist, who thought she might be suffering from anxiety.

'By this stage it was really getting me down,' says Imogen. 'I knew it wasn't all in my head, but I was being questioned.'

Finally, a cause was found after another gynaecologist adopted a different approach. 'She couldn't see anything wrong but asked me to walk around town until the aching started, and then come back,' says Imogen.

'When I returned she examined me and could feel an enlarged vein pushing against my cervix. She diagnosed pelvic congestion syndrome, which means I had developed varicose veins in my pelvis.

Dominic Dodd, consultant-vascular surgeon at the Sheffield Vascular Institute and Thornbury Hospital, Sheffield, says this is a very under-diagnosed condition.

'One in three women experiences pelvic pain in their lives, and research suggests 10 to 30 per cent of chronic cases are caused by pelvic congestion syndrome,' he says.

'Although we have been aware varicose veins can develop in the pelvis, it is only in the last two to three years, with the improvements in imaging, that we are able to make an accurate diagnosis.

Widespread

This makes it difficult to give precise figures, but it's likely that tens of thousands of women have this debilitating condition. Women affected are most commonly in their 30s or 40s; the problem tends to arise after childbirth.'

Varicose veins develop when the small valves which prevent blood from flowing the wrong way fail to work. Mr Dodd adds: 'The blood pools in the veins, causing them to become swollen, enlarged and painful. Varicose veins are most commonly found in the legs, but they can develop in the pelvis, usually after several pregnancies.

'This is because during pregnancy there is increased blood flow which causes veins to become engorged; additional pressure in the pelvis from the baby also adds to the likelihood of varicose veins developing.

'Sometimes the valves and veins simply do not recover. While varicose veins in the legs are visible, when they develop in the pelvis they are hidden and often undiagnosed.'

Like people with varicose veins in the legs, those with pelvic varicose veins experience intensified pain after standing for a long time because an upright position causes blood to pool in the swollen veins.

The best way to diagnose the condition is with scanning, says Dr Paul Crowe, an interventional radiologist and specialist in pelvic congestion syndrome at Heartlands Hospital in Birmingham.

Developments in CT scanning and ultrasound mean radiologists can measure blood flow in real time and see the direction of the flow. This enables them to pinpoint the affected area.

'Pelvic congestion syndrome needs to be diagnosed and treated by a gynaecologist working together with an interventional radiologist,' says Dr Crowe.

'The problem is that in many hospitals this doesn't happen and gynaecologists may not know that their colleagues have the ability to treat varicose veins in the pelvis.'

Getting the right diagnosis is difficult enough, let alone the right treatment, as Imogen found. 'I felt hugely relieved to finally have a diagnosis,' she says. 'But the gynaecologist said there wasn't very much that could be done, although if the pain was severe, a hysterectomy could be considered. I felt back at square one.'

Mr Dodd says: 'While a hysterectomy may help, it isn't a well-targeted treatment. It's radical and would no longer be recommended for this syndrome.'

Looking for her own solution, Imogen searched the internet and found Dr Crowe, one of the pioneers of the new treatment for pelvic congestion syndrome, which is available only in a small number of UK hospitals.

Surgeons make a tiny needle puncture into a vein in the groin, and dye is injected to show the veins in the pelvis. This is called a venography.

'Like a science-fiction film'

'It was like a science-fiction film,' says Imogen, who had the procedure in January. 'My veins were lit up on a large screen and I could see one vein running from my kidneys to my ovaries which was swollen like a sausage, rather than a normal width, like a shoelace.'

Under X-ray guidance, Dr Crowe projected small metal coils through a catheter into the swollen vein to block off the blood flow, a technique known as embolisation.

'The blood has been flowing in the wrong direction, so it does not harm the vascular system to block off this abnormality,' explains Dr Crowe.

'Embolisation was first developed to stop severe bleeding after trauma, but is very effective for a number of other problems, such as the treatment of fibroids (noncancerous growths).

'Fibroids develop when the muscle wall of the womb grows in an abnormal way. We project tiny particles through a catheter to block the arteries which supply blood to the fibroid, shrinking it without the need for surgery.

'The great benefit of embolisation for pelvic congestion syndrome is that patients feel an almost immediate improvement of their symptoms and they can return to normal within days.'

Treatment takes two hours, and Imogen was able to return home on the same day.

'I didn't feel any discomfort during the procedure or afterwards,' she says. 'After a week I was back to normal and within a month I was pain free.

'This treatment has been a miracle. Pelvic congestion syndrome may not be life-threatening but it can have a very serious impact on your life.

'And when the cause of that pain is unknown, or you are treated as if the problem is in your head, it starts to erode your self-esteem.

'I hope more women will become aware that varicose veins can develop in the pelvis and receive this fantastic treatment.'